title: Outcomes of bladder neck closure for intractable urinary incontinence in patients with neurogenic bladders.
abstract: OBJECTIVE
  Recent reports of outcomes of bladder neck closure for neurogenic urinary incontinence reveal poor initial continence and high vesicourethral fistula rates. We evaluated a large series of patients who underwent complete transection and closure of the bladder neck with modified abdominal stoma creation.
  
  
  METHODS
  The medical records of 52 consecutive patients (23 males and 29 females) undergoing bladder neck closure by a single surgeon between July 1996 and January 2003 were reviewed. Mean follow up was 20 months (range 2-68 months) and mean age was 13.9 years (range 1.5-58 years). Forty-two patients (81%) underwent concomitant bladder augmentation. Catheterizable stomas included 46 appendicovesicostomies (88%) and six Monti tubes (12%). Of the 52 patients, 22 were confined to wheelchairs (42%), and the majority of patients had spinal cord pathology (40/52, 77%). Mean preoperative vesical leak point pressure was 25 cm/H(2)O (range 4-69 cm/H(2)O).
  
  
  RESULTS
  Complete postoperative urinary continence was achieved in 44 patients (88%) after one procedure. Of the six patients who were incontinent (12%), one had a vesicourethral fistula (2%) and five had incontinence at the urinary diversion stoma (10%). Twelve of 50 patients had urinary stomal stenosis (24%), with six requiring urgent evaluation (12%) and six requiring surgical revision (12%). Postoperative urinary continence was unknown in two patients due to inadequate follow-up data.
  
  
  CONCLUSIONS
  Our findings suggest that bladder neck closure is a safe and effective method of achieving urinary continence in children with neurogenic voiding dysfunction. While there are risks of stomal stenosis and fistula formation, modifications in surgical technique may reduce them to acceptable levels.
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles, CA 90049, USA. jonb@aya.yale.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bergman
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lerman
authors.forename: Blaine
authors.initials: B
authors.lastname: Kristo
authors.forename: Andrew
authors.initials: A
authors.lastname: Chen
authors.forename: Maria I
authors.initials: MI
authors.lastname: Boechat
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Churchill